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Indications for elective sigmoid resection in diverticular disease.
Ann Surg 2010; 251(4):670-4AnnS

Abstract

INTRODUCTION

To prevent an acute surgery, classic indications for elective sigmoid resections concerning diverticulitis have usually been based on the number of recurrent episodes. Since 2005 these indications have been challenged, primarily because the majority of patients first present themselves with acute complications at their first episode.

METHODS

Between 1990 and 2000, a cohort analysis was conducted involving all patients admitted to the VU University Medical Center with the diagnosis of diverticulitis, with a follow-up until January 2009. To identify those patients who might benefit from elective sigmoid resection, several risk factors were analyzed.

RESULTS

Of 291 patients examined, 111 (38%) were treated conservatively and 180 (62%) underwent surgery, of which 108 acute and 72 elective. The conservatively treated episodes of diverticulitis showed a recurrence rate of 48% (88 patients). Indications for elective surgery were recurrent attacks of diverticulitis with persistent complaints (36%), complaints of stenosis (40%), fistula (14%), persistent abscesses (3%), and recurrent diverticular bleeding (7%). Of the 74% of the patients approached laparoscopically, the overall morbidity was 22% with no mortality. The main indication for an AO was perforation with general peritonitis, holding for 57% of the acutely operated patients. Other indications were abscesses (22%), stenosis with obstruction (11%), failure of conservative therapy (6%), or diverticular bleeding (4%). Hartmann's procedure was the most frequently performed procedure (58%). This acutely operated population was associated with high morbidity (56%) and mortality (13%), perforation leads to 10% mortality and other causes to 3%. Of those patients undergoing acute surgery, 20% had a history of diverticulitis. Moreover, risk factor analysis showed that those patients having one or more of the following indications: (1) using immunosuppression therapy, (2) having chronic renal failure, or (3) collagen-vascular diseases, had a significant 5-fold greater risk (36% vs. 7%) of a perforation in recurrent episodes of diverticulitis.

CONCLUSION

In the treatment of diverticular disease, indications for an elective sigmoid resection should not be based on the number of episodes only. Clear indications for elective sigmoid resections are complaints of stenosis, fistulas, or recurrent diverticular bleeding. Furthermore, an elective sigmoid resection might be justified in high-risk patients, after a conservatively treated episode of diverticulitis, who use immunosuppression therapy and have chronic renal failure or collagen-vascular diseases.

Authors+Show Affiliations

Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. br.klarenbeek@vumc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20224374

Citation

Klarenbeek, Bastiaan R., et al. "Indications for Elective Sigmoid Resection in Diverticular Disease." Annals of Surgery, vol. 251, no. 4, 2010, pp. 670-4.
Klarenbeek BR, Samuels M, van der Wal MA, et al. Indications for elective sigmoid resection in diverticular disease. Ann Surg. 2010;251(4):670-4.
Klarenbeek, B. R., Samuels, M., van der Wal, M. A., van der Peet, D. L., Meijerink, W. J., & Cuesta, M. A. (2010). Indications for elective sigmoid resection in diverticular disease. Annals of Surgery, 251(4), pp. 670-4. doi:10.1097/SLA.0b013e3181d3447d.
Klarenbeek BR, et al. Indications for Elective Sigmoid Resection in Diverticular Disease. Ann Surg. 2010;251(4):670-4. PubMed PMID: 20224374.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indications for elective sigmoid resection in diverticular disease. AU - Klarenbeek,Bastiaan R, AU - Samuels,Michelle, AU - van der Wal,Maarten A, AU - van der Peet,Donald L, AU - Meijerink,Wilhelmus J, AU - Cuesta,Miguel A, PY - 2010/3/13/entrez PY - 2010/3/13/pubmed PY - 2010/5/4/medline SP - 670 EP - 4 JF - Annals of surgery JO - Ann. Surg. VL - 251 IS - 4 N2 - INTRODUCTION: To prevent an acute surgery, classic indications for elective sigmoid resections concerning diverticulitis have usually been based on the number of recurrent episodes. Since 2005 these indications have been challenged, primarily because the majority of patients first present themselves with acute complications at their first episode. METHODS: Between 1990 and 2000, a cohort analysis was conducted involving all patients admitted to the VU University Medical Center with the diagnosis of diverticulitis, with a follow-up until January 2009. To identify those patients who might benefit from elective sigmoid resection, several risk factors were analyzed. RESULTS: Of 291 patients examined, 111 (38%) were treated conservatively and 180 (62%) underwent surgery, of which 108 acute and 72 elective. The conservatively treated episodes of diverticulitis showed a recurrence rate of 48% (88 patients). Indications for elective surgery were recurrent attacks of diverticulitis with persistent complaints (36%), complaints of stenosis (40%), fistula (14%), persistent abscesses (3%), and recurrent diverticular bleeding (7%). Of the 74% of the patients approached laparoscopically, the overall morbidity was 22% with no mortality. The main indication for an AO was perforation with general peritonitis, holding for 57% of the acutely operated patients. Other indications were abscesses (22%), stenosis with obstruction (11%), failure of conservative therapy (6%), or diverticular bleeding (4%). Hartmann's procedure was the most frequently performed procedure (58%). This acutely operated population was associated with high morbidity (56%) and mortality (13%), perforation leads to 10% mortality and other causes to 3%. Of those patients undergoing acute surgery, 20% had a history of diverticulitis. Moreover, risk factor analysis showed that those patients having one or more of the following indications: (1) using immunosuppression therapy, (2) having chronic renal failure, or (3) collagen-vascular diseases, had a significant 5-fold greater risk (36% vs. 7%) of a perforation in recurrent episodes of diverticulitis. CONCLUSION: In the treatment of diverticular disease, indications for an elective sigmoid resection should not be based on the number of episodes only. Clear indications for elective sigmoid resections are complaints of stenosis, fistulas, or recurrent diverticular bleeding. Furthermore, an elective sigmoid resection might be justified in high-risk patients, after a conservatively treated episode of diverticulitis, who use immunosuppression therapy and have chronic renal failure or collagen-vascular diseases. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/20224374/Indications_for_elective_sigmoid_resection_in_diverticular_disease_ L2 - http://Insights.ovid.com/pubmed?pmid=20224374 DB - PRIME DP - Unbound Medicine ER -